A Closer Look at Pharmacy Technicians

■■ A Closer Look at Pharmacy Technicians An important component of discussions around the pharmacy workforce shortage issue is the appropriate use of technicians in various practice settings, the extent to which technicians are licensed and regulated, and the level of training necessary for technicians. Simultaneously, the growth of the number of pharmacy technicians presents a boon to the profession and a substantive challenge. On one hand, the use of technicians helps to address the dramatic shortage of pharmacists that exists in today’s marketplace. That shortage is expected to increase. Technicians are being used in a variety of ways in many different venues. As referenced in the “2002 White Paper on Pharmacy Technicians: Needed Changes Can No Longer Wait,” it is noted that there are as many as 250,000 technicians operating in the United States. Functioning under the management of licensed pharmacists, technicians can perform repetitive, rote tasks that free pharmacists to deal with issues that necessitate their extensive training and expertise. In this manner, they provide a definite boon to the profession. On the other hand, the lack of standardization in the preparation requirements for technicians is an Achilles’ heel for the profession. While the profession vests technicians with the provision of direct service to the public, training and education requirements vary dramatically from state to state. In some jurisdictions, technicians must have successfully completed comprehensive education programs. Others mandate that technicians become certified through the Pharmacy Technician Certification Board. Employers often mandate in-service training to introduce the new technician to their roles, but this is at the discretion of the employer, creating great variations. Alarmingly, in some states, all that is required is a modest registration fee, without attestation to training of any sort. The 2002 white paper is an update of a white paper on pharmacy technicians that was originally published by the American Pharmaceutical Association and the American Society of HealthSystem Pharmacists in 1996. The Council on Credentialing in Pharmacy authorized an update to the piece to reflect the dynamic changes that have occurred in the intervening years. The Council on Credentialing in Pharmacy is dedicated to credentialing programs in pharmacy that meet established standards of quality that will contribute to significant improvement in the pharmaceutical care of patients and the overall public health. The council strives to introduce standardization into postlicensure training for pharmacists and training for technicians. Its members include: • Academy of Managed Care Pharmacy • American College of Apothecaries • American Council on Pharmaceutical Education • American Society of Consultant Pharmacists • Board of Pharmaceutical Specialties • Pharmacy Technician Certification Board • American Association of Colleges of Pharmacy • American College of Clinical Pharmacy • American Pharmaceutical Association • American Society of Health-System Pharmacists • Commission for Certification in Geriatric Pharmacy Similar to the individual pharmacist-supervisor bearing the responsibility for the technician’s work product, the profession has a responsibility to assure that technicians are properly educated and trained to undertake the work assigned to them. Without standardization of professional training requirements for technicians, the profession is deficient in meeting its responsibility to society. The 2002 white paper is mandatory reading for anyone concerned with this issue. It clearly lays out the challenge to the profession.


■■ A Closer Look at Pharmacy Technicians
An important component of discussions around the pharmacy workforce shortage issue is the appropriate use of technicians in various practice settings, the extent to which technicians are licensed and regulated, and the level of training necessary for technicians. Simultaneously, the growth of the number of pharmacy technicians presents a boon to the profession and a substantive challenge.
On one hand, the use of technicians helps to address the dramatic shortage of pharmacists that exists in today' s marketplace. 1 That shortage is expected to increase. Technicians are being used in a variety of ways in many different venues. As referenced in the "2002 White Paper on Pharmacy Technicians: Needed Changes Can No Longer Wait," it is noted that there are as many as 250,000 technicians operating in the United States. Functioning under the management of licensed pharmacists, technicians can perform repetitive, rote tasks that free pharmacists to deal with issues that necessitate their extensive training and expertise. In this manner, they provide a definite boon to the profession.
On the other hand, the lack of standardization in the preparation requirements for technicians is an Achilles' heel for the profession. While the profession vests technicians with the provision of direct service to the public, training and education requirements vary dramatically from state to state. In some jurisdictions, technicians must have successfully completed comprehensive education programs. Others mandate that technicians become certified through the Pharmacy Technician Certification Board. Employers often mandate in-service training to introduce the new technician to their roles, but this is at the discretion of the employer, creating great variations. Alarmingly, in some states, all that is required is a modest registration fee, without attestation to training of any sort.
The 2002 white paper is an update of a white paper on pharmacy technicians that was originally published by the American Pharmaceutical Association and the American Society of Health-System Pharmacists in 1996. The Council on Credentialing in Pharmacy authorized an update to the piece to reflect the dynamic changes that have occurred in the intervening years.
The Council on Credentialing in Pharmacy is dedicated to credentialing programs in pharmacy that meet established standards of quality that will contribute to significant improvement in the pharmaceutical care of patients and the overall public health. The council strives to introduce standardization into postlicensure training for pharmacists and training for technicians.

• American Society of Health-System Pharmacists • Commission for Certification in Geriatric Pharmacy
Similar to the individual pharmacist-supervisor bearing the responsibility for the technician' s work product, the profession has a responsibility to assure that technicians are properly educated and trained to undertake the work assigned to them. Without standardization of professional training requirements for technicians, the profession is deficient in meeting its responsibility to society. The 2002 white paper is mandatory reading for anyone concerned with this issue. It clearly lays out the challenge to the profession.

■■ Impact of the ALLHAT Study Results on Managed Care
The results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were released on December 17, 2002. Up to that time, many clinicians and managed care Pharmacy & Therapeutics (P&T) committees relied on the JNC VI (Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure) guidelines that were published in 1997. 1 Based on evidence-based studies, these guidelines strongly encouraged the use of low-cost diuretics and beta adrenergic blockers as the preferred initial therapy for most patients diagnosed with hypertension.
Though hundreds of clinical studies have been published since 1997, most had fewer patient numbers, lower-risk patients with milder forms of hypertension, and limited comparisons with other classes of pharmacological agents. The JNC has patiently waited for the results of ALLHAT before updating their national guidelines. How will the angiotensin converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs) compare to the diuretics in patient outcomes? Are the increased costs of these agents balanced by improved clinical outcomes, including lower mortality and fewer hospitalizations? Many health care dollars have awaited the decision from ALLHAT and JNC VII on which drug is preferred for hypertension.
The ALLHAT study was a practice-based, randomized clinical trial of antihypertensive pharmacologic treatment (also cholesterol treatment in a subset) in more than 40,000 high-risk patients over the age of 55 years, with a large minority representation. To be included, patients had to have stage 1 or stage 2 hypertension with at least one additional cardiovascular risk factor: history of myocardial infarction (MI) or stroke, any revascularization procedure, documented atherosclerotic heart disease, type 2 diabetes